More women should reap the benefits of cardiac rehab

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Joining a cardiac rehab program can pay huge dividends in terms of vitality, psychological and emotional health, and longer life-yet women are still under-represented in these programs.

“It’s unfortunate because heart disease is a major women’s health issue,” says Dr. Paul Oh, Medical Director of the cardiac rehabilitation and secondary prevention program at Toronto Rehab. “Women can benefit just as much as men from these programs. They should be accessing them in greater numbers.”

So why aren’t they? “Women may not be referred for treatment or rehab as often as men,” says Dr. Oh. “They also may have domestic or social obligations that make it harder to attend rehab programs. Or, they may simply not have access to transportation.”

A recent study of approximately 900 heart patients from 10 Ontario hospitals showed that 28 per cent of patients were referred for cardiac rehab, and that men were twice as likely as women to be referred. In an analysis of 7,000 patients referred to Toronto Rehab’s cardiac rehabilitation program between 1999 and 2004, 79 per cent were men and only 21 per cent were women.

Cardiovascular disease is the number one killer of Canadian men and women-accounting for 32 per cent of deaths among men and 34 per cent of deaths among women in 2002, according to the Heart and Stroke Foundation. “That makes it an equal opportunity disease,” says Susan Marzolini, Cardiac Rehab Supervisor and Research Coordinator at Toronto Rehab. “But the number of women being referred for cardiac rehab is very inequitable.”

Researchers believe obstacles may include patients themselves, their health-care providers and the health system. Women are usually 10 years older than men when they begin to experience symptoms of cardiovascular disease. By that time, they often have other health complications such as diabetes, hypertension or arthritis.

“Physicians may not refer these older women for cardiac rehab, thinking they are not as motivated to exercise,” says Susan. “The older woman is more likely to be single than the older man, so women probably have less social or spousal support. Our own analysis showed that transportation is definitely a bigger problem for women than men.”

The Toronto Rehab study also identified that women over 70 often dropped out of cardiac rehab due to musculoskeletal (MSK) problems such as arthritis. “Recognizing that these issues can limit one’s ability to participate fully in rehabilitation, we are looking at developing an MSK program to help women with these problems and hopefully enable them to better participate in their cardiac rehab program,” says Dr. Oh.

He is also exploring ways to have heart patients automatically referred for cardiac rehabilitation. “Automatic referral systems are extremely effective in getting more people into cardiac rehab. They probably double participation.”

Cardiac rehab programs aren’t only for heart attack survivors. Women at high risk-for instance, those with diabetes-can benefit even if they haven’t yet developed heart disease. Core components of Toronto Rehab’s year-long outpatient program include:

Aerobic exercise, such as walking or bicycling. By the end of the program, most participants walk several miles, most days of the week.

“Cardiac rehab programs help reduce the risk of heart attack and death,” says Dr. Oh. “Participants’ blood pressure and cholesterol levels are better controlled. They are fitter, stronger and better able to carry out day-to-day activities. Women shouldn’t miss out on these potential benefits.”

Anne McRae, 78, enrolled in Toronto Rehab’s cardiac rehab program after heart valve and bypass surgery. “I feel great,” says Anne. “I walk farther than ever before-three and a half miles, three times a week and I even do weight training.”

Anne also spends time with her husband of 56 years, her seven children and her 16 grandchildren. She cleans her condominium, does her shopping, and volunteers in her church outreach program where she visits “a couple of senior ladies-more senior than myself” – once a week. She also volunteers every month at her local food bank.

“Cardiac rehab has given me a new and more positive outlook on life,” says Anne. “It’s made me a more content and confident person.”

Adds Dr. Oh: “The bottom line is, if you are a woman with a heart problem-or at high risk of developing one – consider a cardiac rehab program.”